State of Maternity Care

November 28, 2012 BY ImprovingBirth

By Rebecca Dekker, PhD, RN, APRN

Today’s guest post comes from Rebecca Dekker, PhD, RN, APRN, author of www.evidencebasedbirth.com. Rebecca is a researcher and a nursing professor who recently joined the executive board of ImprovingBirth.org. You can follow Rebecca’s articles from Evidence Based Birth on her Facebook page and on Twitter.

On Labor Day 2012, I created this table to mark the “state of maternity care” in the United States. As we draw close to the end of 2012, I have updated this table and re-posted it here on ImprovingBirth.org. The new table can be shared as an image or as a PDF here—and please feel free to share, pin, tweet, email, and print! The references are available both here at ImprovingBirth.org and Evidence Based Birth (click here).

Interestingly enough, at the very moment I was composing this table on Labor Day, nearly 10,000 women were rallying across the nation for evidence-based maternity care. Women all across the U.S. stood up together with each other and with their families and said—to our healthcare system, to our providers, and to each other—“You know what? We can do better. We deserve respectful, evidence-based maternity care.”

In my opinion, women hold more power than they think. As women rally together on the streets—in greater numbers each year—and say, “We can do better,” then I believe it will happen. We will see an improvement in birth.

In fact, the main reason I have become involved in ImprovingBirth.org is so that someday, my daughter won’t have to fight for evidence-based care— for her, it will be a given.

This work is my gift to her.

* Please note, continuous updates to table and references are made as necessary; refer here for most current information through 2012.

*In 2007, 27% of low-risk females with no prior cesarean birth had a C-section. (The majority of this percentage consists of first-time mothers; however, because this includes a small number of women with prior children, this number may differ slightly from other data reported on the internet). Data accessed from September 2012 from HealthyPeople.gov. Click here to see the healthy people data set. Scroll down to MICH 7.1 and click on the link that says “Reduce cesarean births” to see the data.

National Quality Forum. NPP Maternity action team. 2012. This is a multi-disciplinary team (including representatives from ACOG, midwifery, nursing, and many other organizations) that joined together in 2012 to work on reducing the C-section rate in the U.S. Accessed November 25, 2012. Read more about the Maternity Action Team at this website.

American Academy of Family Physicians. Trial of labor after cesarean, formerly trial of labor versus elective repeat cesarean section for the woman with a previous cesarean section. 2005. Accessed November 23, 2012. Read the free full text here.

*In this table, “artificial induction” refers to labor induction with medications. a. Artificial induction with Pitocin (Oxytocin):U.S. Food and Drug Administration. Oxytocin drug label. 2008. The BLACK BOX is the FDA’s strongest warning for drugs available on the U.S. market. Read the black box warning against elective induction with Oxytocin on this label here. b. Artificial induction with Cytotec (Misoprostol): U.S. Food and Drug Administration. 2009. FDA Alert: Risks of Use in Labor and Delivery. Read the alert here.

Alfirevic Z, Devane D, Gyte GM. Continuous cardiotocography (ctg) as a form of electronic fetal monitoring (efm) for fetal assessment during labour. Cochrane database of systematic reviews. 2006:CD006066. Read the summary here. There is no reference for “intermittent” electronic monitoring because no studies have ever been conducted on this method of monitoring.

The information in the table refers to water during the first stage of labor only (not during pushing/birth). Hodnett ED, Gates S, Hofmeyr GJ, et al. Continuous support for women during childbirth. Cochrane database of systematic reviews. 2011:CD003766. Read the summary here.

While i have only one child, I was present at several hospital births. I have never seen disregard for the mothers wishes in what care and birth they wish to have. Never have i heard abusive language. As i admire your presence and purpose to make things better, your going about it all wrong. Doctors and OBGYN’s choose effective safe methods that they are comfortable with to ensure both mother and infant survive the birthing process. If Birthing was so simple we would just stay at home and lay on our living room floor with a bucket of warm water. Its deadly and a highly dangerous surgical procedure. While i have met and been with women who have had surgical procedures during the birthing process that changed altered or made sex life after painful, i sympathize but understand there is a good possibility they might not have survived the process with out it.

Some of us do stay home with a bucket of warm water (and maybe even a highly trained midwife) and give birth with great results. You have been misled to think it is a “deadly and a highly dangerous surgical procedure”. No. Some births are dangerous while the vast majority are not. Many “routine” and unnecessary interventions that are in place in most hospital settings cause complication that end up to be very dangerous.

I will always have more faith in women’s intuition than physicians’ opinions when real evidence is lacking. I think the movement for improving birth addresses this perspective. Birth is not a surgical event. I birthed my three children in my home with no bells, whistles, or machines that go “bing.” Women’s bodies are capable of bringing forth children. They have been doing so for thousands of years without meddling hands, drugs, or machines. What women really need from those around them is support – to empower them as they work through and conquer the challenge that is birth. The rewards for doing so are many and amazing! Please, no fear mongering; it is not helpful. Thank you.

Sounds like a spoof of a headline, doesn't it? But it's real. The American Congress of Obstetricians and Gynecologists (that's THE organization for ObGYns) published a study this month reporting that just one-third of their clinical guidelines met a standard of "good and consistent scientific evidence." PushNews from The Big Push for Midwives Campaign…

Lamaze International today launched an amazing video and campaign called "Push for Your Baby." The amount of time and energy that went into this project is evident. These are all stories that birth professionals have lived right alongside their clients. Many organizations are getting on board to make a change in our communities and question…

I was 20 when I got pregnant with my first child. I made all the typical assumptions back then. I went to my primary doctor for an OB referral. I had no idea I had a choice. I thought that I went to the OB, he would tell me all I needed to know about…